| NPI | 1689165425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1857992) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NH 04636) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2024-05-21 |